管理式照護對腦中風醫療利用之影響; The Influence of Managed Care on the Health Care of Stroke

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Title:	管理式照護對腦中風醫療利用之影響;The Influence of Managed Care on the Health Care of Stroke
Authors:	吳恩瑄;En-Hsuan Wu
Contributors:	醫務管理學研究所
Keywords:	腦中風;管理式照護;復健;醫療利用率;Stroke;Managed Care;Rehabilitation;Medical Center;Regional Hospital;Local Hospital;clinic;diagenostic quantity
Date:	2008-07-25
Issue Date:	2009-08-12 16:22:08 (UTC+8)
Abstract:	我國實施全民健保以來，醫療費用快速成長導致健保財政上無法負擔，便開始一連串仿造美國管理式照護手段，管理式照護泛指所有意欲控制醫療費用的支付制度，皆可稱為廣義的管理式照護。本研究主要在探討管理式照護制度實施後對於腦中風復健醫療利用率之影響。研究對象為腦中風病患，西元1999年7月1日至2001年6月30日所擷取的合格病患為對照組、西元2005年1月1日至2006年12月31日為實驗組，研究資料來源為全民健康保險學術研究資料庫，分析腦中風病患在各科別、不同醫院層級、不同區域的醫療利用率(平均就診次數、平均住院天數、平均住院費用、平均門診費用)於管理式照護實施前後是否有所差異。研究結果顯示，首次診斷為腦中風病患(ICD-9-CM 430-438排除ICD-9-CM 435)，實驗組人數有4187人，對照組有3548人。在管理式照護實施後門診醫療利用率上，整體而言門診費用是顯著增加，平均看診次數在醫學中心顯著增加，但在地區醫院及區域醫院平均看診次數反而顯著下降，顯示管理式照護的實施對於量抑制作用，對於不同層級的醫院醫療利用率的抑制作用造成結果卻不盡相同，醫學中心在醫師薪水PPF制度下，醫師可能?d了本身醫師收入，仍然會以衝看診量為優先考量，且醫院則會增加每次看診費用來增加收益。住院醫療利用率分不同科別來看，管理式照護實施後復健科平均住院天數明顯上升，其他科的平均住院天數卻顯著下降。可能為管理式照護的介入導致急性醫療科別為健保幾付的利潤，紛紛將病人縮短於急性醫療科別的住院天數，而將病人排擠至慢性的復健科住院，此現象對品質之影響值得探討。 After carrying out National Health Insurance, start heading for the management type in the United States care mode gradually. Because the increasing medical expense is make our fiscal problems can''t be bear of. The Managed Care is generally speaking only that all of the payment system to control medical expense ,and all can be called the management type of the generalized Managed Care system. This research is mainly understand the influence of carrying out Managed Care system to the medical use rate on stroke rehabilitation. Using stroke case to realize the western medicine, we defined July 1st in 1999 went to in 2001 on June 30th for the Control Group, and January 1st 2005 to December 31th for the Experimental Group.According to 1999~2004 the data analysis of the academic research database of the national health insurance, examining to stroke for the first time (ICD-9-CM 430-438 expel the ICD-9-CM 435) , Experimental Group is 4187 people, the Control Group is 3548 people. The out-patient service medical treatment utilization after carrying out Managed Care , by all accounts the out-patient service expenses is an obvious increment, the average out-patient times in obvious increment in medical center, but the average out-patient times are on the contrary obvious to descend in Local Hospitals and Regional Hospitals. The caring implement of the Managed Care repress to the quantity, but it caused different repressing results to different hospital grades. The in-hospital medical use rate in different hospital department, the management type care implement behind average hospitalization number of the rehabilitation section obviously rises, but the average hospitalization number of the other department is obvious to descend.
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